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April 28, 2010

Wearing a Kippah and a Surgical Cap

http://www.jewishjournal.com/tribe/article/wearing_a_kippah_and_a_surgical_cap_20100428

Photo by Dan Kacvinski

Photo by Dan Kacvinski

“What happens in California when you have a baby, if you’re not Jewish? Who does the circumcision? Any idea?”

I am sitting on the couch in Dr. Samuel Kunin’s home office in Tarzana, and I am being quizzed. If there is a more passionate speaker on the subject of circumcision than this retired urologist and full-time mohel, I’ve not met him.

Kunin answers his own question. “Obstetricians,” he says. He barely pauses before moving on. “Who do OBs take care of?”

This one I know: Women.

“Women!” Kunin says, throwing a well-manicured hand up in the air. California’s obstetricians are not, as Kunin deftly puts it, “penis-oriented” — and yet they perform more circumcisions than the state’s urologists. “I’m not knocking them,” Kunin says, “because some obstetricians do good circumcisions.”

That constitutes high praise from Kunin, who, by his own estimate, has done more than 9,000 circumcisions in his career, and it’s a compliment he’s looking to dispense more widely — specifically, by training his medical and mohel colleagues. Kunin has taught circumcision technique to numerous classes of obstetricians at Kaiser Permanente hospital, and, for more than 25 years, he has taught the practical part of a course run by Hebrew Union College-Jewish Institute of Religion in Los Angeles that trains doctors and nurses to become mohels. (He took the course himself back in 1984, the first year it was offered.)

The doctor-mohel-instructor is also quite the kibitzer. Kunin says that back when he was a full-time surgeon, he “enjoyed the office as much as the operating room.”

“You could always tell my charts because I had all sorts of drawings, and I took the time to explain everything.” This is still true today. Kunin is as likely to refer to photos on his iMac as he is to do a quick hand-drawn illustration, but his goal remains the same: “I want my patients to be partners with me in their care,” Kunin says, “and I don’t think that that’s changed from the time I was in an office as a full-time urologist to being a mohel.”

Kunin says he wears “both a kippah and a surgical cap” when he works as a mohel, and that dual identity is most apparent in the work he does with his adult conversion clients.

“Before I do anything,” Kunin says, “I have them sit down, and I explain to them Genesis 17, which is the basis of why we do circumcision.” The lesson isn’t limited to scriptural references, and Kunin points to a copy of a hieroglyphic on display in his office. “That shows a circumcision being done on a man going through puberty in Egypt,” he explains.

“Abraham was 3,700 years ago, and that’s at least 4,400 years ago, so I point out the fact that Jews did not invent circumcision. Circumcision was around long before Judaism.”

The 12th century philosopher and physician Maimonides laid out many of the standards for circumcision still in place today, but modern medicine has made a number of improvements since then — including developing new methods of anesthetizing patients. And though many of his urology colleagues would use general anesthesia, Kunin prefers a method of local anesthetic — for both his infant and adult patients. “I have a lot of nervous people come in,” Kunin says, reading the look on my face perfectly, “and [afterward] they say, ‘Wow, that was easier than going to get my teeth pulled.’ ”

For non-Jewish men who were circumcised at birth, “you can’t re-circumcise them to convert,” Kunin explains. To “make the circumcision covenantal,” Jewish law requires a procedure called hatafat dam brit (drawing the blood of the covenant). Kunin uses a tiny lancet to take a single drop of blood, and he does this in his home, free of charge.

As a general principle, Kunin says, “I don’t want anybody not to be able to afford a bris,” and it’s clear that he believes deeply in the value of circumcision to the Jewish people. “It’s something we’ve been doing for 3,700 years. It’s the one thing that’s persisted even when Egyptians, Greeks, Romans, Spanish inquisitors — and Nazis and Communists in my lifetime — all banned circumcision, and somehow there’s been this common thread that’s kept us going.”

He believes in circumcision from a medical point of view just as deeply — “no study has ever said anything against it” — which is why he finds the prevailing attitude toward the procedure in the medical establishment frustrating.

“Nine out of 10 urologists are not adept at, or trained to, or want to do circumcisions on newborns,” Kunin says. “When I presented a couple of posters at the [annual meeting of the Western Section of the American Urological Association], I had a couple of chiefs of urology walk by and say, ‘I’ve never even done a circumcision.’ ”

“In medicine, circumcision is see-one, do one, teach-one,” Kunin says. “That’s just the way it is.” But he’s working to change that — no matter what hat he’s wearing.

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